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Maryland Small Business Health Insurance Information
The purpose of this guide is to provide a general overview of maryland small business health insurance. the guide reviews small business health insurance options for maryland small businesses..
Building a successful business is hard work. Finding affordable small business health insurance doesn’t have to be. All small businesses face special challenges when it comes to finding and getting health insurance coverage. Luckily, recent health care reform legislation provides small businesses with special opportunities to secure affordable health insurance.
Maryland Core Small Business Health Insurance Options
When evaluating your small business health insurance options in Maryland, you should immediately compare the costs and benefits of the following three options:
Offering Traditional Small Business Health Insurance Coverage,
Offering a Defined Contribution Health Plan that Reimburses Employees for Individual Health Insurance Coverage, and
Maryland Small Business Health Insurance Overview
There are two primary categories of health insurance for small businesses to choose from:
Individual health insurance,
Group health insurance.
1) Individual Health Insurance
Individual health insurance plans are health insurance plans purchased by individuals to cover themselves or their families. Anyone can apply for individual health insurance. Small business owners who can’t offer group coverage due minimum contribution (or minimum participation) requirements typically purchase individual and family plans for themselves and their families. In 2014, insurance companies will no longer be able to decline individuals for individual health insurance based on a pre-existing medical condition. Also, starting in 2014, there are new special tax incentives available to businesses and employees when employees purchase individual health insurance. In some cases, self-employed persons who purchase their own health insurance may be able to deduct the cost of their monthly premiums. When small businesses decide on the individual health insurance route, they often create a "Pure" Defined Contribution Health Plan to reimburse employees tax-free for individual premiums .
2) Group Health Insurance
Group health insurance plans are a form of employer-sponsored health coverage. Costs are typically shared between the employer and the employee, and coverage may also be extended to dependents. In certain states, self-employed persons without other employees may qualify for group health insurance plans.
Four Types of Maryland Small Business Health Insurance Plans
Whether you’re looking at individual health insurance or group health insurance, there are several different types of health plans available. The four you should absolutely know are:
PPO Health Insurance Plans,
HMO Health Insurance Plans,
HSA-Qualified Health Insurance Plans, and
Indemnity Health Insurance Plans.
The plan type that is best for you and your employees depends on what you and your employees want, and how much you are willing to spend. Here’s a brief review of the four popular types of health insurance plans:
1) PPO Health Insurance Plans
PPO or “Preferred Provider Organization” plans are the most common. Employees covered under a PPO plan need to get their medical care from doctors or hospitals on the insurance company’s list of preferred providers in order for claims to be paid at the highest level.
2) HMO Health Insurance Plans
HMO stands for “Health Maintenance Organization.” HMO plans offer a wide range of health care services through a network of providers that contract exclusively with the HMO, or who agree to provide services to members. Employees participating in HMO plans will typically need to select a primary care physician (“PCP”) to provide most of their health care and refer them on to HMO specialists as needed.
3) HSA-Qualified Health Insurance Plans
HSA-qualified plans are typically PPO plans designed specifically for use with Health Savings Accounts (HSAs). An HSA is a special bank account that allows participants to save money – pre-tax – to be used specifically for medical expenses in the future. Section 105 Healthcare Reimbursement Plans (HRPs) are often used in place of HSAs due to their advantages for employers.
4) Indemnity Health Insurance Plans
Indemnity plans allow members to direct their own health care and generally visit any doctor or hospital. The insurance company then pays a set portion of the total charges. Employees may be required to pay for some services up front and then apply to the insurance company for reimbursement.
Maryland Small Business Resources*
Maryland Health Insurance Coverage:
Group Plans: There is a maximum 6-month look-back/12-month exclusionary period for pre-existing conditions on enrollees that do not have prior coverage. Benefits will vary depending on the chosen plan. Pre-existing health conditions covered.
Individual Plans: Assorted plans depending on medical needs. There is a maximum look-back period of 60 months and a maximum exclusion period of 24 months for pre-existing conditions on enrollees that do not have prior coverage. Elimination riders are permitted . Limits on pre-existing health conditions may apply.
COBRA: Coverage available for 18-36 months depending on qualifying events. Benefits are what you had with your previous employer. Pre-existing health conditions covered.
HIPAA: Benefits are based on program selected. There is no expiration of coverage. Pre-existing health conditions covered.
HIPAA: Premium assistance that pays employer-sponsored health insurance or Cobra premium available. Pre existing health conditions covered.
Maryland Health Insurance Eligibility:
Group Plans: Guaranteed coverage for companies with 2-50 employees. Eligible employees must work at least 30 hours a week. Owner can count as an employee. Owner name on business license must draw wages from the company.
Individual Plans: Eligibility is subject to medical underwriting. If you are denied coverage for a medical condition, you may be eligible for AHIP, or PCIP.
COBRA: Guaranteed coverage available for employees who work for businesses with 20 or more employees. Employees have 60 days from date of termination to sign-up.
HIPAA: Must have had 18 months of continuous coverage and completely exhausted Cobra or state continuation coverage. Must not have lost coverage due to fraud or non-payment of premiums. You have 63 days to enroll.
HIPAA: Must qualify for Medicaid and have access to Employer-Sponsored Insurance or Cobra.
Maryland Health Insurance Monthly Cost:
Group Plans: Costs depend on employer contribution and the + 20% of the Insurance company’s Index rate.
Individual Plans: Costs for Individual coverage vary. There are no rate caps.
COBRA: Costs vary between 102% to 150% of group health rates.
HIPAA: Premiums will depend on plan chosen.
HIPAA: Reimburses the full employer-sponsored insurance premium amount by check monthly. Pays the insurance company directly for people on COBRA or eligible small businesses.
Maryland: Average “Single” Premium per Enrolled Employee for Employer-Based Health Insurance, 2011*
Maryland: Average “Family” Premium per Enrolled Employee for Employer-Based Health Insurance, 2011*
Maryland: Average “Employee-Plus-One” Premium per Enrolled Employee for Employer-Based Health Insurance, 2011*
Maryland: Average Per Person Monthly Premiums in the Individual Market, 2010*
Small Business Health Insurance Reform
Are you ready for health care reform ("ACA") in 2014?
Today, employers are more stressed than ever. Here’s why:
The business environment is uncertain,
Employer-sponsored health insurance costs increase annually, and
New fees and penalties take effect next year, and most employers don’t fully understand how this will affect their financials.
It is time for employers to examine the specifics of healthcare reform, and start thinking strategically vs. emotionally. Change is hard. However, employers that educate themselves and plan ahead can avoid severe financial impacts.
The more change and disruption your business can embrace, the more cost savings (for both the company and your employees) you will be able to realize over the long term. In order to embrace this change, you must be familiar with the key aspects of ACA. For many small businesses, the solution to healthcare reform is simple: Offer a “Business Expense Account” for Healthcare. A new vehicle, called a Healthcare Reimbursement Plan (HRP), allows employers to get out of the health insurance business, and simply give select employees monthly allowances to spend on their own health insurance policy in a state health insurance exchange.
Listed below are key ACA components to consider when choosing small business health insurance.
Individual Health Insurance Tax Subsidies
Beginning 2014, individuals will have access to tax subsidies to buy private health insurance through the public exchange. These subsidies will be for those who enroll in a silver plan through the exchange. The subsidy caps the cost of individual health insurance at 2% - 9.5% of their household income if their household income is less than 400% above the federal poverty line. This equates to roughly $90,000 per year for a family of four.
Click here for more information on the premium subsidies.
Individual Health Insurance Tax Penalties
The Individual Mandate requires most individuals to purchase health insurance, or else pay a penalty on their tax return each year. The intention of the individual penalty is to reduce the "Free Riding" effect in the health insurance market (a free rider is someone who is healthy and does not purchase health insurance until they need it.
Click here for more information on individual tax penalties.
Small Business Health Insurance Tax Credits
Small businesses with up to 25 full-time equivalent employees may qualify for a tax credit for offering employee health benefits. The credit is broken in to two phases. Phase 1 (2010-2013) includes a tax credit worth up to 35% of a small business’s health insurance costs. Phase 2 (2014 and beyond) includes a tax credit up to 50% of a small business’s health insurance costs.
Click here for more information the tax credits.
Small Business Health Insurance Tax Penalties
Starting January 1, 2015, Employers with 50 or more full-time equivalents who do not offer minimum essential coverage can face monthly penalties if at least one employee uses a premium tax credit to obtain health insurance through the state health exchange. If you do not have more than 50 employees, you are not subject to these penalties.
Click here for more information on the business tax penalty.
The Future of Small Business Health Insurance - Defined Contribution Plans
Defined Contribution Plans allow employers to offer health benefits without offering a traditional group health insurance plan. Instead of paying costs for a specific group health plan, employers allocate tax-deductible monthly allowances for their employees to spend on private health insurance and other medical expenses tax-free.
Features of defined contribution plans include the following:
Employee Choice – employees choose a health insurance plan that best fits their needs.
Fixed Cost – employers control health care costs by allocating fixed monthly allowances for their employees.
Savings – employers using Defined Contribution Plans typically cost less than group health plans which results in saving for both the employer and employee.
Next Steps – Evaluate Your 3 Core Options
Immediately compare the costs and benefits of the following three options:
Offering a Defined Contribution Health Plan that Reimburses Employees for Individual Health Insurance Coverage, and
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Maryland Group Health Insurance & Employee Benefit Plans
Taylor Benefits Insurance has been providing exceptional service for over 25 years in the state of Maryland. We pride ourselves on creating customized benefits packages for companies of all sizes, from an eight-employee family business to a multi-national corporation.
With our resources and products, we can provide your eligible employees with any or all of the many services we offer, including:
- Group health insurance plans
- Medical, dental , and vision insurance
- Employee benefits and wellness plans
- Affordable Care Act (ACA) compliance
- Disability insurance ( short and long term )
- Group retirement plans
- 401(k) plans , set-up and servicing
- Employee pensions
- Health savings plans (HSA)
- Group life insurance
- Long term care plans
- Section 125 cafeteria plans
- Maryland large group health insurance
Operating as an independent agent allows Taylor Benefits to utilize resources and products from a wide variety of different insurance providers instead of being limited to just one. This gives us an advantage because we can truly customize insurance coverage options that offer the highest level of coverage without breaking the bank.
Taylor Benefits is the industry leader in providing comprehensive AND affordable products for group policies and employee benefits. We currently service many cities in Maryland, such as Baltimore, Waldorf, and Rockville, just to name a few.
Taylor Benefits Insurance has a longstanding popular reputation with some of the more notable large businesses in the state of Maryland but never fails to provide the same exceptional service to the “mom and pop” businesses as well. And if you need information concerning the State Personnel Management System (SPMS), we’ve got you covered.
Call us today at the number on the top of the page for a FREE estimate and available group benefits options in Maryland, or complete the simple form on the right for a no-obligation, customized proposal for your Maryland-based business.
Maryland Large Group Health Insurance Plans
Large employers may allow their workers a choice of health insurance coverage plans. If one option meets the affordability standard in the ACA, others can cost more. For example, the employee may be able to choose between an HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), and POS (Point of Service) option.
Point of Service (POS) options are increasing, often with high deductibles and HSAs. These trends allow workers to have greater control over their health care choices and costs but also require that the consumer develop a more sophisticated understanding of the rules. For example, a POS program combines some aspects of both the HMO and the PPO structure.
A POS typically involves coordinating care through a primary care physician as an HMO does. That doctor refers the patient to specialists and other providers. However, more like a PPO, the POS allows the use of out-of-network medical providers, albeit at a higher cost than in-network services. Typically, an HMO only covers out-of-network care in an emergency.
A critical provision of the ACA is improving transparency in the conditions around claims payment related to PPO and HMO services. For example, if a subscriber seeks care from a facility within their approved network, but the individual practitioner providing a service isn’t covered, the patient must be informed in advance, or the insurer will have to pay the charge regardless.
Maryland Small Business Health Insurance Plans
The ACA doesn’t require small companies to offer health insurance coverage to eligible employees (small for this purpose means fifty or fewer full-time workers.) However, the ACA has some provisions to help employers that want to. Those that choose to provide the benefit must comply with rules for small businesses.
One requirement is minimum essential coverage, which is the same as the large companies must provide. Insurance coverage must also be available for all workers in the company (not just managers or highly compensated staff).
Finally, to receive the Small Business Health Care Tax Credit, the employer must pay at least half of the premium cost for eligible employees.
Small business owners can go directly to SHOP for information. Still, they may want to consult a broker like Taylor Benefits Insurance to evaluate and compare potential plans. Small business group options are sorted into tiers with metal name identifiers to help categorize the value. Bronze plans, for example, have a lower premium but higher costs for service. In contrast, a platinum plan will have the highest premium but a lower price when the subscriber needs to use the coverage. In between are silver and gold.
Maryland Employee Benefit Plans and Employee Benefit Packages
Benefits for employees are often a critical part of the overall compensation package. They can add thirty percent to the worker’s total pay. Some of that expense is unavoidable because it includes Social Security and Medicare contributions the employer must make and state-mandated costs for workers’ compensation insurance.
Health insurance is costly, and generous time-off policies can also be expensive. Still, competitive Maryland employers know that they must keep their benefits programs robust to attract and retain the best workers. Of course, that doesn’t mean every company needs free lunch, onsite childcare, or concierge services. But when you decide on health benefits, be sure that you communicate the information to all your eligible employees.
Many employees don’t seem to be aware of all the available offerings or how to gain access to them. Providing regular information sessions about the packages will highlight what’s included and probably increase participation.
Apart from the many benefits offered to eligible employees, the state offers other forms of paid leave to contractual employees who work at least 30 hours per week. Another in Maryland is the Tuition Remission program, where employees have an opportunity to take classes at a University system.
How does the Affordable Care Act affect my Maryland business?
The Affordable Care Act , more popularly known as Obamacare, was a program put into place to help the uninsured population in the US receive affordable healthcare. Although there were a lot of positives for employees, the mandate did not bode as well with business owners who were forced to restructure their current healthcare benefit offerings drastically.
Luckily for business owners in Maryland, Taylor Benefits was able to help out by evaluating current policies, making suggestions, and providing affordable solutions. Alternatively, Taylor Benefits has been instrumental in building company packages from the ground up in order to determine the best course of action for employers affected by the ACA.
If you need this type of attentive insurance assistance and are operating a Maryland-based business, please complete the form on the right or call the number at the top of the page for a FREE, customized proposal guaranteed to meet your needs exactly.
Frequently Asked Questions About Health Insurance And Employee Benefit Plans in Maryland
If you have some concerns about health insurance plans and employee benefit plans in Maryland, here are a few answers to some common questions:
In Maryland, What Is Considered a Large Group for Health Insurance Plans?
Large group health insurance is defined as a health insurance plan for a group of 50 or more employees. This health insurance plan is available to both small and large businesses. For large-group health insurance, there are no maximum numbers.
Large group health insurance plans provide all employees with the same coverage, making them easy to work with and quick enrollment for new employees. Employees with healthcare requirements may prefer a customized insurance package.
How Do Small Business Group Health Insurance Plans work in Maryland?
Insurance plans for two groups can never be the same due to differences in terms and conditions. Employees have the option to opt out of the group plan. The small group can be divided into tiers, and employees can choose between basic and advanced add-ons, with premium payments split evenly between the two parties.
Group health insurance plans may be extended to employees’ immediate family or eligible dependents at an additional cost.
What Are the Different Types of Benefits Offered in Maryland?
Benefits are perks that an employer provides to its employees in addition to a salary. Life insurance, retirement, 401k, paid leave, disability, and medical insurance are the most common employee benefits. Employers may also provide other benefits to employees and their families, depending on the company, including but not limited to behavioral health like vision and dental plans, legal insurance, pet insurance, college debt relief, and optional benefits.
How Much Do Employee Benefits Cost on Average in Maryland?
In 2018, employee benefits accounted for 32% of all employer compensation costs in the United States. However, the average cost of your benefits is primarily determined by the perks provided by your employer.
Health insurance is an integral part of all employee benefits, with annual fees ranging from $5000 to $30000 depending on the type of plan and insurer.
Retirement plans are also a popular perk that most employers provide, with matching contributions ranging from 2% to 6% of your salary. Employee benefits such as disability insurance, leave benefits, life insurance and supplemental retirement plans, which can cost anywhere from $2000 to $5000 in a calendar year, are also very common. Based on what is covered in the package, the average total cost of your employee benefits is calculated.
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Todd Taylor with Taylor Benefits gives our small business the kind of personal service we need. Insurance benefits are important to our employees and Todd helps us find a balance between benefits and value. Todd responds immediately to my phone calls & e-mails. He has even gotten in touch with me on a Sunday when we were in need of coverage answers immediately. We are very pleased with the hands-on service Todd and his staff provide.”
- Ken and Linda Orvick, Orvick Management Group, Inc.
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Small Business and Nonprofit Health Insurance Subsidies Program Work Group
Pursuant to SB 632 (2022), MHBE convened “a workgroup to study and make recommendations relating to the establishment of a Small Business and Nonprofit Health Insurance Subsidies Program to provide subsidies to small businesses and nonprofit employers and their employees for the purchase of health benefit plans.” MHBE submitted the workgroup’s findings and recommendations in the form of a report to the Governor, Senate Finance Committee, and House Health and Government Operations Committee.
The workgroup members included:
- Individuals from the small business and nonprofit community, including owners, employers, and employees;
- Health insurance carrier representatives;
- Licensed health insurance producers; and
- Representatives of business, nonprofit, consumer advocacy, and other organizations.
The workgroup studied:
- The health insurance coverage needs of small employers, nonprofit employers, and their employees;
- Objectives and target metrics for the Program;
- Whether subsidies under the Program should be available for the purchase of qualified health plans offered to small employers on the Exchange and the purchase of health benefit plans offered to small employers outside the Exchange;
- Subsidy eligibility and payment parameters for the Program;
- The administrative structure and infrastructure investments required for implementation of the Program, including any requirements for the Exchange, health insurance carriers, and any other entities involved in the implementation of the Program; and
- The duration of the Program;
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- The sources and levels of funding needed to support the Program.
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Maryland Small Business Health Insurance Plans 2023
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Maryland Small Business Health Insurance Plans 2023 . The following is an overview of the rules that govern small group health insurance plans in the State of Maryland.
The information that is discussed below includes the laws that have been mandated by the Affordable Care Act (ACA or "Obamacare"), as well as the laws that are required by Maryland State government.
If you own and operate a MD small business and you already offer small group health insurance or you're thinking about offering small group health insurance - this guide can help you better understand the regulations, requirements and available Maryland small business health insurance plans available.
Learn how to get Maryland small business health insurance plans for 1 to 50 employees. The best small business health insurance providers in MD offer affordable rates, flexible coverage options and access to a large network of medical providers.
Below are some answers to commonly asked MD small business health insurance plan questions:
How Much Does Maryland Small Business Health Insurance Cost?
What are the small business health insurance regulations in maryland, does maryland participate in the affordable care act, what are the affordable care act requirements for maryland small businesses.
- How Are MD Health Insurance Premiums Are Determined?
What Types Of Health Insurance Plans Are Available For Maryland Small Businesses?
The average price of a standard Maryland small business health insurance policy ranges from around $583 to over $1706 per employee per month based on; single or family, location, coverages offered, deductibles and more.
In the State of Maryland, there are specific laws regarding small group health insurance. According to the laws that have been established by state government, all qualifying small businesses must be sold small group health insurance.
Furthermore, small businesses that employ more than 2 but fewer than 50 employees must be offered the same small business health insurance policies that all small businesses are offered.
If Maryland health insurance companies choose to, they are legally allowed to impose two requirements. One of those requirements is that health insurance companies may opt to impose minimum enrollment requirements, which requires small businesses have a minimum amount of group members purchase the policy.
If this requirement is imposed and a small business does not meet the enrollment requirement established by the health insurance company, the Maryland small business health insurance plans can be rescinded.
Secondly, health insurance companies in Maryland can require employers to pay a certain amount of their employees' health insurance premiums prior to agreeing to sell a small business a small group health insurance policy.
While companies that sell small business health insurance can regulate which small businesses are eligible to purchase policies, as per Maryland law, it is illegal for any health insurance company to charge higher premiums because of the health status of a group.
With that said, however, the cost of premiums can vary and be based on certain key factors, such as the age and family size of the group. Furthermore, it is illegal for health insurance companies to cancel the policies of any Maryland small business if one of the insured becomes ill.
According to Maryland Insurance Administration , Marylanders have a number of options available to help cover the cost of health care, depending upon their employment status, coverage needs and ability to pay:
- Coverage through an Employer's Plan - Ask your employer whether it offers health insurance benefits and whether you are eligible to participate in your employer's group plan. Some employers only offer this benefit to full-time employees; others offer it to part-time employees as well. Some employers also pay a portion of their employees' health insurance premiums.
- Individual Health Insurance - You can purchase an individual policy for yourself or your family during the annual "open enrollment period," when everyone is eligible to apply for new health insurance, or within 60 days of certain qualifying life events.
- A Family Member's Policy - If you are married and your spouse has health insurance, you may be able to be added to that policy. Similarly, if you are under the age of 26, you may be eligible for coverage under a parent's policy.
- COBRA or Maryland Continuation of Coverage - If you are enrolled in your employer's group plan and you lose your coverage, you may be eligible to continue your existing coverage under COBRA, which is a federal law that gives some employees the ability to continue health insurance coverage after leaving employment or under Maryland's Continuation of Coverage law.
- Medicare - Depending upon your age or health status, you may qualify for Medicare. Medicare is the federal health insurance program for people: (1) age 65 or older, (2) under 65 with certain disabilities, and (3) of any age who have end-stage renal disease.
- Medicaid - Depending on your household income, you may be eligible to receive Medicaid benefits. You can enroll in Medicaid at any time.
- Maryland Children's Health Program - f you are pregnant or have a child under age 19, you may be able to obtain coverage through the Maryland Children's Health Program (MCHP).
In 2010, the Affordable Care Act (ACA or "ObamaCare") was passed by the United States Congress and was signed into law by Obama. Following its passage, provisions of the law have continued to be phased in, and as of January 1, 2014, the majority of American citizens and legal residents of the United States are required, by law, to have qualifying health care coverage.
If they fail to have coverage, they are responsible for paying an annual tax penalty for each month they aren't insured, which is known as the "individual mandate".
The cost of the penalty for failure to have qualifying coverage is $95 per adult and $47.50 per child, or 1% of your total taxable income; whichever amount is higher - as much as $285 per family. In 2017, the penalty increased, and has continued to increase thereafter.
Qualifying Exemptions For The Individual Mandate
Individuals who meet one of the following are exempt from the individual mandate and the associated tax penalties in MD:
- Illegal aliens
- Jailed individuals
- Religious objections
- The cost of health insurance coverage is higher than 8% of your household income
- Those who aren't covered for less than three months during the calendar year
- Those who have hardship waivers
- Your income level is blow the 100% poverty level
If you're a small business owner in Maryland, you must provide your employees with insurance. This is a requirement that was put into place by the Affordable Care Act.
Referred to as the Employer Shared Responsibility provision, all employers must offer their employees at least one of the ACA-compliant Maryland small business health insurance plans, otherwise then can face fines of up to $2,000 per employee.
Maryland small business owners can purchase coverage for their employees through the state's Small Health Option Program (SHOP) exchange, or from a private insurance agent or broker.
Affordable Care Act Standardized Essential Health Benefits
As per the ACA, all qualifying health insurance plans must offer 10 standardized essential benefits.
Depending on the state, additional benefits may also be required. The 10 ACA standardized essential benefits are as follows:
- Ambulatory patient services (medical care that is offered without being admitted to a hospital)
- Emergency services
- Hospitalizations, such as overnight stays and surgical procedures
- Lab services
- Mental health and substance abuse disorder services, including behavioral health treatments, such as psychotherapy and counseling
- Pediatric health care services, including vision and oral care; however, adult vision and dental coverage aren't essential health benefits under ACA
- Pregnancy, maternity, and newborn care, including before and after birth
- Prescription pharmaceuticals
- Preventative and wellness services, as well as management for chronic diseases
- Rehabilitative and habilitative services and devices, including services and devices for injuries, disabilities, and chronic health conditions
Additional Health Benefits Mandated In Maryland
Not only do small businesses need to offer their employees' health insurance policies that cover the 10 ACA standardized essential benefits, but policies must also include health benefits that Maryland government requires. These additional benefits include the following:
- Bariatric surgery for morbid obesity
- Blood services and product
- Chiropractic care
- Clinical trials
- Congenital anomaly for cleft lip/palate
- Diabetes care management, including equipment, supplies, and self-management training
- Durable medical equipment, including hair prosthesis
- Emergency transportation/ambulance services
- Hearing aids for children
- Home health care services
- Home health care services for additional home visits post-testicle removal
- Hospice care services
- Infertility treatment, including in-vitro fertilization
- Infertility services
- Reconstructive breast surgery
- Outpatient rehab services
- Second opinion coverage for outpatient services
- Skilled nursing facility services
- TMJ disorder diagnosis and treatment
Standardized Maryland Small Business Health Insurance Plans
In order to make it easier to compare costs and benefits, the Affordable Care Act has designated all qualifying Maryland small business health insurance plans to be one of four metal colors, including Bronze, Silver, Gold, and Platinum.
Each of these designations is based on the average amount of health care costs that the plan will cover, which is illustrates at percentages of how much the insurance company will cover for health care, as well as the amount the insured will have to pay out-of-pocket.
All insurance companies that are participating in the federal or state health care exchange program must offer at least the Silver and Gold Maryland small business health insurance plans.
All four of the metal plans have a shared maximum out-of-pocked amount that the insured can be charged during any calendar year. The following table illustrates this information:
As per the ACA, individuals cannot be denied coverage or charged higher premiums because of their past health history, or their gender.
Additionally, look-back and waiting periods cannot be imposed. Additionally, policies are effective when they are issued and all coverage is renewable if the individual chooses to renew the policy.
However, plans can be canceled if the individual fails to pay their premiums or commits fraud.
How Are MD Health Insurance Premiums Determined?
A premium is the amount the insured must pay out-of-pocket in order to maintain their health insurance policy. The premiums that are charged for any of the qualifying metal plans can be based on the following:
- Age of the individual
- Whether or not the individual uses tobacco
- Where the individual lives, based on a rating area
- The number of family members who will be enrolling
While there are several types of health insurance plans to choose from, the following plans are the most popular among MD small business owners:
Health Maintenance Organization - Simply known as an "HMO", this type of plan offers a variety of health-related services via a network of health care providers and hospitals that exclusively contract with the HMO, or who agree to offer their services to members of the HMO. Employees who participate in this type of plan usually have to choose a primary care physician (PCP), and receive most of their care from this physician. If a specialist is needed, the PCP will recommend one that is affiliated with the HMO.
Preferred Provider Organization - More commonly referred to simply as "PPO", this type of health insurance plan is the most common among Maryland small business owners. The insurance company provides a preferred list of health care providers, and employees must receive their medical care from the doctors and hospitals on that list for their claims to be paid at the highest level possible - but they also have the flexibility to see any other provider anywhere in or out of state.
Point-of-Service Plan - Known as a (POS), this type of health insurance plan provides access to health care services at a lower overall cost, but with fewer choices. Members can access care from in-network or out-of-network providers and facilities, but coverage is better when you stay in-network. POS plans may vary, but generally, plans are considered a blend of HMO and PPO plans - offering more flexibility than HMOs, but less than PPOs.
Health Savings Account - A health savings account (HSA) is a special type of bank account that allows participants in the insurance plan to save money that can be used specifically for the medical care they require in the future. HSA-qualified health insurance plans are usually PPO plans that are specifically designed to be used with an HSA.
Indemnity Health Insurance - This type of health insurance plan allows members to control their own health care and to visit any doctor or hospital they choose. The insurance company would then pay a pre-determined percentage of the total charges for the services that were rendered. Employees may have to pay for some types of services up-front and then they can submit a request for reimbursement with the insurance company.
Maryland Small Business Health Insurance Plans - The Bottom Line
We strongly advise business owners to speak with a CPA and a MD health insurance broker before jumping in and getting any type of the Maryland small business health insurance plans available.
Make sure that you know exactly what each option can do for your company and the potential drawbacks associated with it.
Request a free Maryland small business health insurance plans quote in these other MD cities: Aberdeen, Adelphi, Annapolis, Arbutus, Arnold, Aspen Hill, Ballenger Creek, Baltimore , Bel Air North, Bel Air South, Beltsville, Bethesda, Bowie, Brooklyn Park, California, Calverton, Camp Springs, Carney, Catonsville, Chillum, Clarksburg, Clinton, Cloverly, Cockeysville, Colesville, College Park, Columbia, Crofton, Cumberland, Damascus, Dundalk, East Riverdale, Easton, Edgewood, Eldersburg, Elkridge, Elkton, Ellicott City, Essex, Fairland, Ferndale, Fort Washington, Frederick, Gaithersburg, Germantown, Glassmanor, Glen Burnie, Glenmont, Glenn Dale, Greenbelt, Hagerstown, Havre de Grace, Hillcrest Heights, Hyattsville, Ilchester, Kemp Mill, Kettering, Lake Shore, Landover, Langley Park, Laurel, Lochearn, Maryland City, Middle River, Milford Mill, Montgomery Village, North Bethesda, North Laurel, North Potomac, Odenton, Olney, Owings Mills, Oxon Hill, Parkville, Parole, Pasadena, Perry Hall, Pikesville, Potomac, Randallstown, Redland, Reisterstown, Riviera Beach, Rockville, Rosedale, Rossville, Salisbury, Seabrook, Severn, Severna Park, Silver Spring, South Laurel, Suitland, Takoma Park, Towson, Waldorf, Westminster, Wheaton, White Oak, Woodlawn and all other MD cities & Maryland counties near me in the Old Line State.
Learn about Maryland small business insurance requirements for general liability, business property, commercial auto & workers compensation including MD business insurance costs. Call us (443) 407-0500 .
Small Business Health Insurance Plans By State
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Maryland health insurance plans
You have more insurance options for your health than you think, Maryland
If you’re self-employed or without insurance from your employer — in other words, you’re looking for individual or family health insurance in Maryland — you might be looking for Affordable Care Act insurance, what's often called Obamacare. However, we want to make you aware of the whole range of individual and family insurance products we have available in your state.
Plans for health insurance coverage in Maryland
Unitedhealthcare individual & family aca marketplace plans in maryland.
Looking for health care plans on the Affordable Care Act (ACA) Marketplace? UnitedHealthcare Individual & Family ACA Marketplace plans offer affordable, reliable coverage options from UnitedHealthcare of Maryland, Inc.
As part of the American Rescue Plan Act of 2021 and Inflation Reduction Act of 2022 , many individuals and families are now eligible for lower — or in some cases $0 1, 2, 3 — monthly premiums for ACA Marketplace health coverage.
Call 1-800-273-8095 / TTY 711 to talk to a licensed insurance agent.
Already a member with a UnitedHealthcare Individual & Family ACA Marketplace plan? Sign in or call 1-877-265-9199 / TTY 711
Supplemental, dental and vision insurance in Maryland
Hospital & doctor insurance.
Health ProtectorGuard fixed indemnity insurance , 4 underwritten by Golden Rule Insurance Company, can supplement your major medical plan by paying cash for eligible, covered medical services, like a doctor visit, a trip to urgent care or a surgical procedure.
- No deductibles or copays to pay first
- Benefits paid regardless of other insurance
- Money to pay costs not covered by major medical plans, like a deductible
Maryland dental plans
Dental insurance plans, underwritten by Golden Rule Insurance Company, have no age limit restrictions. 5 They offer coverage for the dental services many medical insurance plans don’t include.
Maryland vision plans
Vision insurance plans, underwritten by Golden Rule Insurance Company, have no age limit restrictions. 5 They offer coverage for the vision services many medical insurance plans don’t include.
Accident & critical illness insurance
Accidental injuries and critical illness happen when you least expect them. Those unexpected expenses can strain any budget. Accident insurance 4 and critical illness insurance 4 can help by paying cash benefits for covered injuries or illnesses.
The Accident Pro series of products, underwritten by Golden Rule Insurance Company, combines accident insurance with critical illness, hospitalization, and accidental death and dismemberment coverage all in one. Some plans are guaranteed issue, meaning your application won’t be turned down for preexisting conditions.
Browse coverage options in Maryland
From Baltimore to Rockville, Frederick to Annapolis, explore these Maryland health insurance options and more that may be available now.
Looking for other health plans?
- Small business plans
- Self-employed health insurance plans
- College student health insurance
Need help finding a plan?
Answer a few questions to see which insurance options may be available for you.
Health insurance for individuals who are 65 or older , or those under 65 who may qualify because of a disability or another special situation.
Call 1-844-232-1426 to learn more.
We offer low cost or no cost health insurance plans for those with limited incomes.
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MARYLAND BUSINESS INSURANCE
Wherever you do business in Maryland, a tailored insurance policy from Selective and your independent agent can help protect your unique business.
Maryland has a diverse business environment and robust labor market. Key industries in the state include manufacturing, technology, and education.
No matter the size of your business, you need commercial insurance to help protect it. The right coverage can also help you grow your operations.
With trusted agency partners throughout Maryland, Selective and your independent agent can provide a comprehensive insurance solution that fits your unique needs.
BUSINESSES WE INSURE IN MARYLAND
Across all of Maryland, from Baltimore to Hunt Valley, Selective and our independent agency partners are proud to serve businesses in multiple industries, including:
- Private Schools
- Technology Companies
- Auto Services, including Repair Shops and Body Shops
- Religious Institutions
- Social Services
Don't see your profession? At Selective, we offer commercial insurance to over 400 types of businesses. Find a local independent agent and get a Maryland business insurance quote today.
Maryland Business Insurance from Selective
Selective and your independent agent can help you reduce risk and protect your business by customizing a business insurance solution tailored to you.
- Business Interruption
- Commercial General Liability Insurance
- Commercial Property Insurance
Business interruption insurance helps protect your company against income loss in case of a covered incident that forces you to suspend business operations. This type of insurance also assists with rent or lease payments, relocation costs, employee wages, taxes, and loan payments until your business can reopen.
Business interruption insurance does not usually cover damages or losses from flooding, earthquakes, mudslides, and other natural disasters. However, there are additional coverages you can purchase to help protect against these risks.
Business liability insurance in Maryland can help protect your company from liability claims, including allegations of third-party property damage, bodily injury, false arrest, reputational damage, and more. In addition to providing financial protection, commercial general liability insurance may help pay for legal fees related to lawsuits against your company and medical costs if someone sustains a bodily injury on your business property.
Commercial property insurance can help protect your physical assets, including furniture, inventory, and business equipment. This may also pay for repair or replacement costs in the event of losses due to fires, vandalism, or other covered risks that may cause structural damage to your insured building or its contents.
Ensuring the safety and security of your assets is crucial for any company, as is keeping your business running after a loss, so talk to your independent agent about Maryland business insurance from Selective.
“My claim experience I feel was handled professionally and efficiently. Thank you.” Maryland Customer
Optional Insurance Coverages for Maryland Businesses
While general liability and property insurance are essential for every business, Selective offers additional insurance coverages and enhancements in Maryland to help address your specific risks and needs, including:
- Workers Compensation can help pay for medical treatment, rehabilitation, lost wages, and disability benefits if an employee has a work-related injury or illness. This can also help protect you as a business owner by helping pay for legal costs in the event an injured worker sues your business.
- Commercial Flood Insurance in Maryland helps protect your physical buildings or structures from flood-related losses, including damage to the foundation, walls, HVAC, wiring, and more. It also covers the contents, including furniture, equipment, inventory, and more.
- Product Recall Coverage can help your business navigate product recalls, minimize financial losses, and pay for covered expenses such as hiring temporary employees or product disposal.
- Management Liability Insurance is a suite of coverages that can help protect your business from financial losses not typically covered under standard commercial general liability policies. MLI coverages include Directors and Officers (D&O), Employment Practices Liability Insurance (EPLI), and Fiduciary Liability (FLI).
- Commercial Auto Insurance can help protect your company vehicles and drivers on and off the road. It may also help pay for medical bills if you, your employees, or passengers are injured in an accident in which your company is at fault.
Cyber Liability Insurance for Maryland Businesses
Cyberattacks, including phishing, ransomware, and social engineering, are a growing risk that all Maryland businesses should prepare for. Cyber Liability Insurance from Selective can help protect your business against losses related to cybercrime.
Don’t Risk Your Maryland Business to Cybercrime https://www.selective.com/about-selective/unique-perspectives/articles/insuring-your-small-business-against-risks-in-post-pandemic-world
Get Broad and Convenient Coverage in Maryland from a Business Owners Policy
A Business Owners Policy (BOP) is a practical insurance solution that can help protect your business’s assets against losses caused by property damage, lawsuits, or other accidents. Instead of purchasing separate policies for property, liability, and business income insurance, a BOP conveniently bundles these basic coverages into a single, budget-friendly insurance policy.
Your independent Maryland Insurance agent can help you decide if a Business Owners Policy meets your needs.
FIND AN INDEPENDENT INSURANCE AGENT IN MARYLAND
Frequently asked questions about maryland’s business insurance, how much does commercial insurance cost in maryland.
The cost of commercial insurance varies from business to business in Maryland. Factors that can affect your cost include (but are not limited to) the number of employees, location, payroll, and the types of vehicles you own. Your local independent insurance agent can help you assess your risks and customize a commercial insurance policy to match.
Is Workers Compensation Insurance Mandatory for Employers in Maryland?
Maryland businesses must carry worker’s compensation insurance if they employ one or more full-time, part-time, seasonal, or occasional workers. Without workers’ compensation insurance, you may be held liable for all benefits provided under Maryland law if an employee gets injured or becomes ill on your premises. A worker’s compensation policy may also provide injured workers with a portion of lost wages if they take time off to recover.
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Open enrollment under way in Maryland’s health insurance marketplace, with a new carrier and expanded savings for young adults
Thank you for supporting our journalism. This article is available exclusively for our subscribers, who help fund our work at The Baltimore Sun.
Open enrollment on Maryland’s health insurance marketplace kicked off with a new carrier, expanded savings for young adults and changes to value plans.
Marylanders have between Nov. 1 and Jan. 15 to purchase private plans on the marketplace, the Maryland Health Benefit Exchange said in a news release. Those who qualify for Medicaid may enroll at any time of year.
The marketplace includes plans that cover many health services for free or a low cost, Michele Eberle, the exchange’s executive director, said in the release. Plans include coverage for vaccines; screenings for diabetes, high blood pressure and some cancers; prescription medicines; mental health, and other health services.
Coverage starts Jan. 1 for plans selected before Dec. 31 and on Feb. 1 for plans chosen in January.
This year, Marylanders can purchase plans on the exchange from Aetna for the first time, as well as from CareFirst, Kaiser Permanente and United Healthcare. Vision plans are new this year to the marketplace, Eberle said.
The Morning Sun
Marylanders between 18 and 37 can get special discounts on plans through a pilot program implemented in 2021 by state legislation introduced by Del. Ken Kerr of Frederick County and Sen. Brian Feldman of Montgomery County.
The pilot program, which was extended during this year’s legislative session, has provided $20 million in subsidies each year to adults with lower incomes to help them purchase health care. Enrollments of people between 18 and 34 reached more than 53,000 in September, according to a report from the exchange — up 16% from last year.
“It has been really successful,” Eberle said of the program. “I can give you a really good example. If you were living in Baltimore City, and you’re age 25, you can get a gold plan for zero payment a month if your income is less than $27,500. And that’s between the federal tax credits and the young adult subsidy tax credit.”
The health benefit exchange also made changes to value plans offered on the marketplace this year to make costs for common health care services clearer and more consistent across insurance companies, the exchange said in the news release.
Value plans, which are designed to have lower out-of-pocket costs and are a particularly good fit for people with high prescription costs, are offered by all insurance companies on Maryland Health Connection. They have lower caps on the amount patients have to pay out of pocket for prescriptions and cover routine services for people with diabetes at no cost, including insulin, primary care visits and certain lab work.
“Our feeling is, we can’t address chronic conditions if people can’t afford what they need to manage their chronic condition,” Eberle said.
Eberle encouraged people who are buying plans on the marketplace to ask for help if they have questions about eligibility or specific plans. Marylanders can connect with an insurance broker or navigator at marylandhealthconnection.gov/find-help .
- > November
Maryland opens enrollment for 2024 health plans, expands savings for young adults
Posted: November 1, 2023 | Last updated: November 1, 2023
Maryland residents can now enroll in health plans for 2024 on MarylandHealthConnection.gov.
Open enrollment runs from Nov. 1, 2023, through Jan. 15, 2024.
Coverage starts Jan. 1, 2024, for plans selected before Dec. 31, and coverage starts on Feb. 1, 2024, for plans selected the first two weeks of January.
“Life can feel unpredictable - be it losing a job, losing Medicaid coverage following the end of the public health emergency, moving to Maryland, turning 26 and aging out of your parent’s plan, or deciding to be your own boss.” said Michele Eberle, executive director of the Maryland Health Benefit Exchange. “Maryland Health Connection has free or low-cost plans to give you peace of mind.”
All plans available through Maryland Health Connection cover many health services at no cost. Vaccines, screenings for diabetes, high blood pressure, and many cancers are included.
This year, the Maryland Health Connection welcomed Aetna as a new health insurance company in addition to CareFirst, Kaiser Permanente, and UnitedHealthcare.
Maryland Health Connection also expanded the savings available for young adults.
Now, Marylanders ages 18-37 can get special discounts for 2024 health plans, as well as other savings.
If you need help enrolling go to MarylandHealthConnection.gov/help to find free assistance near you.
You can get free help enrolling by phone, through virtual support, or in person.
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What small business owners need to know about Medicare now
Baby Boomers own a lot of small businesses.
In fact, according to the US Census Bureau, over half of small business owners are over 55 years of age. That means that right now millions of them are being bombarded with ads and mail about Medicare plans because we are smack dab in the middle of the annual period to enroll in Medicare or change your plan between Oct.15 to Dec. 7.
So listen up: If you’re a small business owner, whether you’re approaching the age you can sign up for Medicare – 65 – or already on Medicare, now’s the time to think about your choice of Medicare plans and think carefully.
This choice can cost you or save you thousands, maybe tens of thousands, of dollars.
When does Medicare open enrollment take place? Here's what to know when picking your plan.
For context, it helps to understand that health insurance for small business owners – and their staff – is jaw-droppingly expensive. Before the Affordable Health Care Act was passed (Obamacare), small business owners over the ages of 50, even 40, were charged such high premiums that it was clear the insurance companies didn’t want us.
Personally, I went without health insurance until my mid-forties. Yes, I know it was stupid, but running a business was expensive. Once I hit 50, the premiums were always over a thousand dollars a month and then over $1,500 a month for lousy coverage.
The ACA changed that. Somewhat. Now, a 55-year-old in California making $50,000 a year can get a “Silver” plan for only $321 a month, and someone making $150,000 a year would pay only $856 for that plan.
If you think the word “only” shouldn’t apply for a monthly premium that high, believe me many older small business owners consider that a bargain.
That’s why many small business owners are thrilled when they qualify for Medicare. It’s about the only benefit of getting older. But it’s a big one.
Yet it can also be confusing. There’s all kinds of terms that sound the same – Medicare, Medigap, Medicare Advantage, Supplemental plans, and on and on.
Let’s start with the basics.
Going solo? Here's why private Medicare plans are set to pass traditional Medicare enrollment
The government program that provides coverage for basic health care. There are different parts to this Original Medicare:
- Part A covers the really expensive stuff: hospitals, skilled nursing, surgery
- Part B covers preventative care, doctor visits, lab tests and so on.
- Part D covers prescription costs.
But Medicare doesn’t cover all the costs – you’ll still pay around 20% of your health care costs, which can be substantial. You’ll also pay the government a premium for Part B. You can choose whether to buy Part D for additional cost.
Medigap or Supplement Insurance
Original Medicare still leaves significant costs and gaps in your coverage, so you can purchase a supplemental plan to lower your out-of-pocket expenses.
There are a number of different plans to choose from, some that cover virtually all of your expenses. Of course, the cost of your premiums increase as your coverage increases. There’s a good chart on the government’s website that compares the features of the different Supplement plans.
Republicans won't touch your Medicare benefits. But insolvency looms without changes.
What is a Medicare Advantage
Offered by private insurance companies, Medicare Advantage plans wrap basic Medicare benefits into one package. They have much lower premiums than Medigap/Supplement plans – some actually have no monthly premiums at all. But you are likely to have co-pays and a yearly deductible.
However, many of these plans offer a number of benefits not included in Supplement offerings, including dental and vision coverage, even gym membership.
What’s the big difference between Medigap and Medicare Advantage?
Advantage plans are cheaper than Medigap/Supplement plans – often a lot cheaper or even ‘free.’ But, of course, there’s a catch – and it’s a big one!
With a Medigap/Supplement plan, you can go to any doctor or hospital that accepts Medicare – anywhere in the US. And you don’t need a doctors’ referral to go to a specialist.
You want to go see a dermatologist or a podiatrist? Just make an appointment; no need to get the approval of your primary physician. And if you want to see a specialist in another state, you can. With some plans – including the most popular Plans F and G – you’ll have virtually no out-of-pocket co-pays or deductibles.
That’s not the case with Advantage programs. They act as HMO’s (Health Maintenance Organizations) or PPO’s (Preferred Provider Organizations). You must go to a doctor or hospital that is in your insurers’ specific “network,” and you must get a referral before going to a specialist.
Any services out-of-network or out of your local area are likely not to be covered. If you move, you may not be covered. You’ll have co-pays and out-of-pocket expenses for most services. Those costs can be huge.
Here's the most important thing to remember: The first year you qualify for Medicare, you can choose any plan you want without health considerations affecting your acceptance or pricing. Insurers can’t reject you because of pre-existing conditions.
Even better, you can keep that plan as long as you keep paying for it. If you choose a less expensive Advantage plan now, you can be rejected from a more comprehensive Supplement plan in the future.
Choosing a Medicare plan? Here are 7 things to consider
For example, let’s say Sam, who owns a graphic design firm, has just turned 65, and she’s signing up for Medicare. She’s had breast cancer. Thank goodness it’s in remission, but she wants to make sure she can see her own oncologist or go for treatment in another state if the cancer comes back.
She can afford the monthly premiums, so she chooses a Supplement plan – in her case, Plan “G,” that will cover all those costs. If she signs up now, when she’s first eligible, she can’t be rejected because of her cancer, and the insurance company can’t kick her off or raise her premiums in the future more than the standard amount set by the government.
However, another Sam, who owns a small car repair shop, has a few health issues and heart disease runs in his family. He’s struggled to pay for health care. He’s thrilled to sign up for an Advantage plan that has no monthly premiums. He also gets dental and vision coverage, and now can join that gym and work out.
But he has to choose a doctor in network, and if his doctor or hospital drops off his plan, he’ll have to find another doctor. More importantly, if he has heart problems in the future, he may face some high hospital bills, won’t be able to go to a specialist that is out-of-network, and is likely not to be able to switch to a more comprehensive Medigap/supplement plan.
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Here’s the other thing to keep in mind: Insurance brokers get paid more for signing you up for an advantage plan than for a Medigap/Supplement plan.
For 2022, for example, an agent could get up a commission up to $573 for a first-time Advantage enrollment (higher in some states, such as $715 in California) while the average commission for enrolling someone in a Supplement plan was $322. So when an insurance broker is urging you to sign up for an Advantage plan, keep in mind they’re going to make more money if you do .
What do I recommend?
- The year you qualify for Medicare, sign up for the best plan you can afford. Insurers can’t reject you because of pre-existing conditions.
- If you can afford one of the best and most popular Medigap/Supplement plans – Plan G or Plan F (Plan F is only available if you qualified for Medicare before 2020) – you’ll have the best coverage.
- If monthly health care premiums are your biggest concern, choose an Advantage plan. Just be aware of the limitations.
- Sign up for something! It’s better to have any plan rather than no plan.
- If you have a pre-existing condition or any condition that might require specialists or out-of-area doctors or hospitals, seriously consider a Supplement plan.
Don’t wait to sign up. Even if you can get health insurance from a spouse’s employer, sign up. Your costs may go up if you wait.
Also, some Republican legislators have expressed an intent to reduce Medicare benefits. If they control Congress and the White House after the 2024 election, I’d expect the age to sign up for Medicare to be increased, possibly to age 70. Those already on Medicare would likely be ‘grandfathered’ in.
I know it’s all a bit confusing, but Medicare is a great boon to small business owners who face some of the highest prices for health insurance. Don’t wait.
Correction: The original publication of this column misstated the proportion of health care costs not covered by Medicare. The correct figure is around 20%.